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CNE Article

Interprofessional Approach in Gero-Oncology

Ashley Leak Bryant
CJON 2018, 22(6), 5-7 DOI: 10.1188/18.CJON.S2.5-7

This supplement provides case studies to highlight the importance of using an interprofessional approach to care for older adults. The Oncology Nursing Society (ONS) has been instrumental in disseminating important work and findings in the care of older adults with cancer.

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This supplement highlights an interprofessional approach to caring for older adult patients with cancer. By 2030, about 70% of all cancer diagnoses will occur in people aged 65 years or older (Smith, Smith, Hurria, Hortobagyi, & Buchholz, 2009); therefore, nurses must be prepared to provide optimal care for this population. This supplement provides case studies to highlight the importance of using an interprofessional approach to care for older adults. The Oncology Nursing Society (ONS) has been instrumental in disseminating important work and findings in the care of older adults with cancer. For example, ONS was the first professional group to acknowledge the importance of geriatric oncology by supporting the creation of the first position statement related to the topic in 1992 (Boyle et al., 1992) and the second in 2004 (Oncology Nursing Society and Geriatric Oncology Consortium Working Group, 2004). The Gero-Oncology Working Group facilitates practicing oncology nurses having the most current data to support their practice. This supplement furthers ONS’s goal by providing scholarly articles focused on complexities of care, challenges and opportunities in caring for diverse older adults with cancer, and resources that can be shared with interprofessional oncology teams.

An article in this supplement by Overcash, Cope, and Van Cleave (2018) discusses caring for the frail older adult with cancer using a comprehensive geriatric assessment and how gero-oncology providers can help manage comorbidities and functional deficits. Goldberg, Burhenn, and Ginex (2018) review assessment, clinical care, and implications for practice when caring for older adults with cancer. Cope, Reb, Schwartz, and Simon (2018) discuss important guidelines for tailoring treatment decisions based on geriatric assessment and acknowledging barriers patients face in adhering to their treatment plans. The use of a transitional care model in the postacute care setting is investigated by Jackson (2018), and the article provides resources to ensure open communication and dialogue among providers in various patient care settings. Davis and Fugett (2018) provide information on financial toxicity for this population and give family and community resources related to insurance coverage, coordination of care, and resources related to unintended consequences.

This article focuses on three questions posed by the current author to gero-oncology experts in nursing, pharmacy, and medicine. These perspectives come from Debi Boyle, RN, MSN, AOCN®, FAAN, an oncology clinical nurse specialist and lead author of the first ONS position statement on gero-oncology; Jody Simon, MS, RPh, a pharmacist and founder of the Geriatric Oncology Consortium; and Hyman Muss, MD, a pioneering medical oncologist within gero-oncology. The areas of concern identified by the respondents provide critical context for the supplement and the field going forward. The supplement’s interprofessional focus aims to show that caring for this population is not a silo or solo experience—it is a team effort. An interprofessional team is critical for providing optimal care to the older adult patient with cancer in this rapidly advancing and changing treatment landscape.

How Should We Prepare for the Coming Wave of Older Adults With Cancer?

Debi Boyle: We should prepare for the coming wave by ensuring there is equivalent emphasis in basic nursing and medical education for care of older adults with cancer. Pediatric courses are a fundamental component of nursing and medical education; a geriatric course should be equally foundational in all educational programs going forward. The prominence of ageism, stereotyping, and bias are common forms of discrimination that should be highlighted. One challenge for the future will be to make people confront their biases. Because of these barriers, gerontologic oncology nursing is not often embraced, but rather dismissed.

Jody Simon: We must prepare for the enormity of this crisis, which is significantly heightened by Baby Boomers. Boomers will increase the number of older adults living with cancer, and medical professionals are not prepared to take care of them. In addition, there is a global issue related to ageism/age bias. Gerontologic oncology is an underpursued and underfunded field of study, unlike pediatrics, which more readily attracts practitioners and specialized hospital facilities. Going forward, nursing and medical schools need an equivalent course for gerontology to what is currently in place for pediatrics.

Hyman Muss: The coming wave of older adults is a complex, time-consuming challenge. My dream is for cancer care to be integrated with geriatric centers that are trained to care for this population. Patient-centered care is a core value that I strongly believe can make patients feel more connected and trusting with their providers. We need to train, build, and increase the number of providers with an interest in this population.

What Are the Three Priorities of Clinical Care?

D.B.: The priority for clinical care of older adults with cancer should be survivorship needs related to increased risk for second and third cancers. Second, we need dedicated pharmacy support related to the myriad of drug–drug interactions and reactions in complementary therapies. This is particularly necessary for older adults, who consume the majority of over-the-counter drugs; therefore, pharmacists are positioned to be the oncology nurse’s best friend in caring for this population. Third, we must address caregiver needs, burden, and stress.

J.S.: This population has been insufficiently studied in pharmacologic literature. Consequently, we should use big data to better understand how to determine medication decisions for this patient population. This would lead to better oncology-related therapeutics. In addition, cancer-related recommendations need to be more closely aligned with clinical trial composition (e.g., age, comorbidities, functional status) and toxicities related to medications.

H.M.: Foremost, we must train all doctors and healthcare providers in geriatric assessment. Next, we should explore funding mechanisms for primary care providers to complete geriatric assessments and provide proven interventions based on patient deficits. Last, we need to work nationally to improve the pay scale for geriatricians and other healthcare providers who care for older adults with cancer.

What Are Your Perspectives on Precision Health?

D.B.: Personalized cancer treatment will look different for each individual. Clinical trial enrollment is key, but not all eligible patients will receive the targeted therapies. We need big data and clinical trials to inform us about next steps as it relates to precision health.

J.S.: The landscape of how we treat these patients is rapidly changing. Increasing attention is paid to understanding how therapies are targeted to patients’ cancer cells and whether patients are candidates for targeted therapy. Explaining the benefits of biopsies and molecular profiling could benefit the patient and others in the long-term, which could then lead to better precision health in this population.

H.M.: We need to develop actionable targeted therapies to improve treatment options for this population. At the moment, older adults are underrepresented in clinical trials of newer agents, and we lack knowledge on the risks and benefits of treatment in the older population. We need to step up efforts to enroll older adult patients in these trials.

Conclusion

This supplement highlights the clinical competencies of various healthcare providers needed to care for this growing population with a variety of unmet needs: physical, psychosocial, functional, and financial. Oncology nurses need to build the capacity of providers, convince policy and institutional leadership about the value of the geriatric assessment to identify potential problems, and increase the allocation of funding to support personalized care for targeted treatment.

About the Author(s)

Ashley Leak Bryant, PhD, RN-BC, OCN®, is an assistant professor in the School of Nursing at the University of North Carolina at Chapel Hill. The author takes full responsibility for the content of the article. Bryant can be reached at ashley_bryant@unc.edu, with copy to CJONEditor@ons.org.

 

References 

Boyle, D., Engelking, C., Blesch, K.S., Dodge, J., Sarna, L., & Weinrich, S. (1992) ONS position paper on cancer and aging: The mandate for oncology nursing. Oncology Nursing Forum, 19, 913–933.

Cope, D.G., Reb, A., Schwartz, R., & Simon, J. (2018). Older adults with lung cancer: Assessment, treatment options, survivorship issues, and palliative care strategies. Clinical Journal of Oncology Nursing, 22(Suppl. 2), 26–35. https://doi.org/10.1188/18.CJON.S2.26-35

Davis, M.E., & Fugett, S. (2018). Financial toxicity: Limitations and challenges when caring for older adult patients with cancer. Clinical Journal of Oncology Nursing, 22(Suppl. 2), 43–48. https://doi.org/10.1188/18.CJON.S2.43-48

Goldberg, J.I., Burhenn, P.S., & Ginex, P.K. (2018). Nursing education: Review of assessment, clinical care, and implications for practice regarding older adult patients with cancer. Clinical Journal of Oncology Nursing, 22(Suppl. 2), 19–25. https://doi.org/10.1188/18.CJON.S2.19-25

Jackson, M.L. (2018). Transitional care: Methods and processes for transitioning older adults with cancer in a postacute setting. Clinical Journal of Oncology Nursing, 22(Suppl. 2), 37–41. https://doi.org/10.1188/18.CJON.S2.37-41

Oncology Nursing Society and Geriatric Oncology Consortium Working Group. (2004). Oncology Nursing Society and Geriatric Oncology Consortium joint position on cancer care in the older adult. Oncology Nursing Forum, 31, 489–490.

Overcash, J., Cope, D.G., & Van Cleave, J. (2018). Frailty in older adults: Assessment, support, and implications for treatment in patients with cancer. Clinical Journal of Oncology Nursing, 22(Suppl. 2), 8–18. https://doi.org/10.1188/18.CJON.S2.8-18

Smith, B.D., Smith, G.L., Hurria, A., Hortobagyi, G.N., & Buchholz, T.A. (2009). Future of cancer incidence in the United States: Burdens upon an aging, changing nation. Journal of Clinical Oncology, 27, 2758–2765. https://doi.org/10.1200/JCO.2008.20.8983

Williams, G.R. (2018). Geriatric assessment: Precision medicine for older adults with cancer. Journal of Oncology Practice, 14, 97–98. https://doi.org/10.1200/JOP.18.00010